Long-term, high-dose opioid prescribing for chronic non-cancer pain in primary care

Background Opioid prescriptions for chronic pain have risen sharply over the last 25 years; harms associated with these drugs are related to dose and length of use.

Aim The main aim of this study was to identify patients prescribed long-term, high doses of opioids in the community and to assess the prevalence of such use.

Design & setting An observational study of opioid prescribing in two demographically dissimilar GP practices was carried out.

Method Details of opioid prescriptions were collected for 22,841 patients, of whom 1,488 (6.5%) were being prescribed opioids on the census date. Exhaustive examination of the data identified all patients who were prescribed oral morphine equivalent doses of 120 mg/day or more for one year or longer.

Results All these patients were being prescribed ≥120 mg/day as a single drug; morphine, oxycodone, fentanyl or buprenorphine, irrespective of opioid polypharmacy. Across both practices, 1.71/1000 patients were identified as long-term, high-dose users of opioid medication for chronic non-cancer pain. Prevalence was similar in the two practices. Repetition of the process until January 2021 showed no change in the pattern.

Conclusion This study offers confirmation that a significant group of patients are prescribed long-term opioid medication for chronic pain at doses which are unlikely to be effective in reducing pain but are likely to have harmful consequences. The findings offer a simple, reliable and practical method of data extraction to identify these patients individually from routinely collected prescribing data, which will help in monitoring and treating individuals and establishing the problem prevalence.